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POSTED
ON KROLL
BUILDING DEPARTMENT I ApplicantFlll
1.
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
0wi1e
Inside Heavy Lines
RESIDENTIAL GAS
LINE
NEW NON-RESIDENTIAL. SIGN
ADD ❑ DEMOL11 RETA NG
ALTER ❑ EXCAVATE�❑ FEN
OR,.x`........ Ft.)
REPAIR n PRE -MOVE F1 SWIM
1 t INBP. POOL
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duly author -
Iced agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work a•lthorlred thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be cum ed in ninety day fOVE0.IN_ BUII.DIN08 Shall be com-
pleted 1n oo v
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission,
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14
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YAIED SETBACK M'
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NT BITE {
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ONCE NUMBER ,
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I.
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EXI8TING STREET R/W ...........FT. DEFICIENCY THIS PROPERTY 1'
COMP, PLAN ST, R/W ............FT. ...........FT. 0
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REMARKS ��]7j •
CRECKED BY
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METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY
t..:
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REMARKS
TYPE CONNECTION I VERIFIED BY I
I.
PERO, TEST I PERMIT NUMBER 5
REMARKS
1;
v �
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
EZ},� •� _ _
f I� I ,y I [ YES Of0
B INSPECTOR REQUIRED (OCCUPANCY GROUP( r
YESN O �.
PLAIN CHECKED SY
THIS SITE IS LOCATED IN THE
REMARKS iYII.7:7^ 1 '
TAX SHOULD BE CODED 31.04. °; f
Q•Pln4P.u1 If
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Plan Check No,................
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORM NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR d-IIe;
APPLICATION APPROVAL ''' 1.4.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac- l
lmowledged in space provided.